Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 044448 | CT |
NPI | 1083709463 |
---|---|
Provider Name | Kevan Clifford Herold |
First Address | New Haven, CT 06536-0805 |
Second Address | New Haven, CT 06520 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |